Chapter 8 Flashcards
Rheumatic fever key histology
Myocarditis with Aschoff bodies that are characterized by foci of chronic inflammation, reactive histiocytes with slender, wavy nuclei (Anitschkow cells), giant cells, and fibrinoid material; myocarditis is the most common cause of death during the acute phase.
What is chronic rheumatic heart disease
CHRONIC RHEUMATIC HEART DISEASE:
Valve scarring that arises as a consequence of rheumatic fever
Results in stenosis with a classic ‘fish-mouth’ appearance
Almost always involves the mitral valve; leads to thickening of chordae tendineae and cusps
Occasionally involves the aortic valve; leads to fusion of the commissures
Other valves are less commonly involved.
How does aortic stenosis arise?
AORTIC STENOSIS:
Usually due to fibrosis and calcification from “wear and tear”
- Presents in late adulthood (> 60 years)
- Bicuspid aortic valve increases risk and hastens disease onset.
May also arise as a consequence of chronic rheumatic valve disease; coexisting mitral stenosis and fusion of the aortic valve commissures distinguish rheumatic
disease from “wear and tear.”
Clinical features of aortic regurg include
Early, blowing diastolic murmur
Hyperdynamic circulation due to increased pulse pressure
Pulse pressure is the difference between systolic and diastolic pressures.
Diastolic pressure decreases due to regurgitation, while systolic pressure increases due to increased stroke volume.
Presents with bounding pulse (water-hammer pulse), pulsating nail bed (Quincke pulse), and head bobbing
Results in LV dilation and eccentric hypertrophy (due to volume overload)
MVP murmur gets louder with…
Click and murmur become louder with squatting (increased systemic resistance
decreases left ventricular emptying).
MR murmur gets louder with…
Holosystolic “blowing” murmur; louder with squatting (increased systemic resistance decreases left ventricular emptying) and expiration (increased return to left atrium)
mitral stenosis
Narrowing of the mitral valve orifice
Usually due to chronic rheumatic valve disease
Clinical features:
Opening snap followed by diastolic rumble
Volume overload leads to dilatation of the left atrium, resulting in:
Pulmonary congestion with edema and alveolar hemorrhage
Pulmonary hypertension and eventual right-sided heart failure
Atrial fibrillation with associated risk for mural thrombi
What is rhabdomyoma associated with?
Benign hamartoma of cardiac muscle
Most common primary cardiac tumor in children; associated with tuberous sclerosis
Usually arises in the ventricle
What is associated with endocarditis with negative blood cultures?
HACEK organisms (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella) are associated with endocarditis with negative blood cultures.
Libman-Sacks endocarditis…
Libman-Sacks endocarditis is due to sterile vegetations that arise in association with SLE. Vegetations are present on the surface and undersurface of the mitral valve and result in mitral regurgitation.
Nonbacterial thrombotic endocarditis is due to…
Nonbacterial thrombotic endocarditis is due to sterile vegetations that arise in association with a hypercoagulable state or underlying adenocarcinoma. Vegetations arise on the mitral valve along lines of closure and result in mitral regurgitation.
causes of dilated cardiomyopathy
Most commonly idiopathic
~Genetic mutation (usually autosomal dominant)
~Myocarditis (usually due to coxsackie A or B) characterized by a lymphocytic infiltrate in the myocardium; results in chest pain, arrhythmia with
sudden death, or heart failure –> dilated cardiomyopathy is a late complication.
~Alcohol abuse
~Drugs (e.g., doxorubicin)
~Pregnancy-seen during late pregnancy or soon (weeks to months) after childbirth
what is restrictive cardiomyopathy
Decreased compliance of the ventricular endomyocardium that restricts filling
during diastole
Causes include amyloidosis, sarcoidosis, hemochromatosis, endocardial fibroelastosis and Loeffler syndrome (endomyocardial fibrosis with an eosinophilic infiltrate and eosinophilia).
